There are “a number” of potential conflicts between Monitor’s new responsibilities to enable integrated healthcare and to prevent anti-competitive behaviour, a new report prepared for the regulator concedes.

It calls for Monitor to publish clear criteria for determining when efforts to coordinate the services patients receive from different NHS providers are likely to pose competition concerns.

This guidance, it says, should also clarify what clinical, financial and strategic information can be shared with other providers and commissioners.

Monitor commissioned the report – from the Nuffield Trust and King’s Fund think tanks, economists Frontier Economics and consultants Ernst and Young – to advise it on how to approach its new duty to “enable” integrated NHS care.

The advisers conclude that the duty will “cut across” a number of other roles ascribed to the healthcare sector regulator in the Health Act, including Monitor’s responsibilities for setting prices for NHS services, licensing providers, guaranteeing continuity of services, and preventing anti-competitive behaviour.

The report adds that the NHS Cooperation and Competition Panel has highlighted “possible distortions in competition” in the integration of acute hospital and community services, where the latter are responsible for referring patients for acute care.

In the Netherlands, it finds, large groups of GPs have contracted collectively for the “provision of integrated care pathways, potentially limiting competition between those GPs”. In some UK case studies, the researchers found providers pulled between “a desire to collaborate more closely with other organisations in the local health system, and a fear of competition enforcement”.

While admitting the duties do not “necessarily” conflict with each other, they conclude: “Therefore in a number of areas, there is a potential (or perceived) conflict which raises questions for Monitor’s competition workstream.”

These included the “communication of Monitor’s rules and approaches” and clarification of “how information can be used”.

They add: “The specific approaches or actions taken by Monitor must be consistent with (or stricter than) UK and EU competition law. This might be particularly the case in relation to rules around information-sharing.”

Monitor is calling for comments on the report’s recommendations to be sent to integration@monitor.nhsft.gov.uk by 13 July.

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